‘State must focus on free medicine and primary health’

DNMUM422295 | 9/15/2018 | Author : Dhaval Kulkarni | WC :478

DNA In-Depth
While governments roll out public-funded medical insurance schemes targeted at the poor, health activist Dr Abhijit More, who is co-convenor of the Jan Arogya Abhiyaan, argues that the focus must be on capacity building in the primary healthcare sector. This will reduce out-of-the-pocket expenses for outpatient care facilities that are not covered by any medical insurance.The mediclaim coverage in Maharashtra is low. There is a vast population untapped by government-funded medical insurance schemes...The penetration of commercial insurance schemes is low. The Maharashtra government launched the Rajiv Gandhi Jeevandayee Yojana (RGJAY) as a publicly-funded health insurance scheme. However, though it coversRead full story

over 900 procedures, the impact is limited. This is because the scheme largely deals with tertiary and selected medical procedure. Every year, around six crore people are pushed into debt due to medical expenses. Substantial expenditure is incurred on OPD procedures and purchase of medicines, which is not covered by insurance schemes.The out-of-the-pocket expenses for other treatments are huge. It is estimated that this covers around 70 per cent of medical expenses with the state government’s schemes just touching 30 per cent, as against developed countries, where the ratio is 20 per cent and 80 per cent respectively.So, should the focus be on strengthening primary and secondary healthcare institutions rather than launching public-funded medical insurance schemes like RGJAY and Ayushman Bharat?The government’s health insurance schemes cover the high-end spectrum and do not tackle OPD charges which are the main components of expenditure. Hence, the focus must be on providing free medicine, diagnostic facilities, and primary healthcare. A high-level expert group under Dr K Srinath Reddy on universal health coverage submitted a comprehensive report stressing that 70 per cent of healthcare expenditure should be on primary healthcare. Primary health facilities are the base of the pyramid and tertiary care is the apex. Here, we are ignoring the base, and that leads to an unsustainable model. Limited resources have to be allocated based on priorities. Hence, priority must be primary healthcare.What can be a possible roadmap for the future?The public healthcare system in Maharashtra must be expanded and strengthened through sufficient investment in primary health. Maharashtra spends just around 3.5 to 4 per cent of its budget and 0.5 per cent of the state domestic product on public health. Our analysis suggests that the average per capita expenditure on public health is just Rs 996 compared to the national average of Rs 1,600. Government hospitals also lack in medicine forcing people to approach private players. This is in contrast with states like Rajasthan and Tamil Nadu which have created good models sans any political interference. The State can do the same in their existing budget without increasing outlays. Doctors need better working conditions, upward professional mobility and access to education for their children. Power needs to be decentralised.

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